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THIS NOTICE
DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
Our Duties
We are required by law to maintain the privacy of your medical information
and to provide you with notice of our legal duties and privacy practices.
We are required to abide by the terms of the Notice of Privacy Practices
currently in effect. We reserve the right to change those terms
and any changes made will be effective for all medical information
we maintain. A copy of a revised notice will be available from our
web site at www.advancedradiology.com, at any of our imaging centers,
or from our Privacy Coordinator by calling (443) 436-1100 extension
1198, or by writing to Advanced Radiology, c/o Privacy Coordinator,
7253 Ambassador Road, Baltimore, MD, 21244. You may also address
questions regarding our privacy practices, your privacy rights,
or requests for additional information regarding your privacy to
this person.
Permitted
Uses and Disclosures
We may use and disclose your medical information in the ordinary
course of our business. We have described some of these uses and
disclosures in the following paragraphs:
- Treatment:
We will provide your doctor or other health care provider with
the results of the diagnostic imaging exams we perform. We may
contact you before the exam to remind you of your appointment
or to talk with you about preparing for the exam. We normally
call you at the contact number you provide us. If you are not
available or your voice mail answers, we will leave a brief message
reminding you of the place and time of your appointment. If applicable,
we will ask you to call us regarding your exam preparations.
- Payment:
We will bill your insurance company, you directly, or another
person that may be responsible for payment of your account. We
may need to contact your health plan to see if they will pay for
the exams your doctor has ordered. Throughout this process, we
may have to release details of your exam and medical condition,
if your health plan or other payor requires this information to
make payment.
- Health Care
Operations: We often have to use specific patient information
to conduct our normal business operations. For example, we routinely
review past exams performed to maintain quality assurance goals.
One type of review we may conduct includes selecting images for
review by another radiologist. Another is to select your billing
information for review by our internal compliance team or by external
auditors. In addition, we may use specific patient information
to demonstrate our skills to an accreditation body. Accreditation
is important to our patients and us because the process causes
us to demonstrate some degree of proficiency in conducting examinations
and maintaining the quality of our equipment.
Disclosures
without Authorization
We may use and disclose medical information about you, without your
specific authorization, as follows:
- Disclosures
Required by Law: We may be required by federal, state, or local
law to disclose your medical information.
- Public Health
Activities: We may disclose your medical information to a public
agency, such as the Food and Drug Administration (FDA), if you
experience an adverse effect from any of the drugs, supplies,
or equipment we use.
- Victims of
Abuse, Neglect, or Domestic Violence: We may be required to disclose
your medical information if we feel that you have been abused
or neglected.
- Health Oversight
Activities: We may be required to disclose your medical information
to Medicare or a related agency if they select your case for a
medical review.
- Judicial
and Administrative Proceedings: We may have to disclose your medical
information if we receive a subpoena from a judge or administrative
tribunal.
- Law Enforcement:
We may have to disclose your medical information in conjunction
with a criminal investigation by a federal or state law enforcement
agency.
- Serious Threats
to Health or Safety: We may be required to disclose your medical
information if, in our opinion, doing so will help avert a serious
threat to the public.
- Military
Personnel: We may disclose your medical information to the appropriate
command authorities.
- Worker's
Compensation: We may disclose your medical information to comply
with laws regarding worker's compensation.
Patient
Rights
You have certain rights with respect to your medical information.
Requesting
Restrictions: You may ask us to limit our use or disclosure
of your protected health information. We are not required to agree
to your request, but if we agree to it, we will abide by your request
except as required by law, in emergencies, or when the information
is necessary to treat you. Your request must: 1) be in writing,
2) describe the information that you want restricted, 3) state if
the restriction is to limit our use or disclosure, and 4) state
to whom the restriction applies. You may revoke your restriction
at any time by contacting our Privacy Coordinator as noted on the
first page. We may ask to reschedule your exam while we consider
your request.
Confidential
Communications: You may ask that we communicate with you
in a particular way, or at a certain location, to maintain your
confidentiality. Your request must be in writing, tell us how you
intend to satisfy your financial responsibility, and specify an
alternate way that we can contact you confidentially. You do not
have to give a reason for your request. In certain circumstances,
we may require payment in full at the time you have your exam. You
may revoke your request at any time by contacting our Privacy Coordinator
as noted on the first page. We may ask to reschedule your exam while
we consider your request.
Inspect and
Copy: You may request access to inspect and copy your medical
information maintained in our records, including medical and billing
records. Your request must be in writing. We will act on your request
within 21 working days after we get the request. If we must deny
your request, we will send you a written denial. If this happens,
you may request a review of the denial. We may charge you a fee
for providing copies. If that is the case, we will advise you of
the cost of those copies at the time that we arrange for you to
pick them up or have them delivered to you. We will compute these
fees based on state guidelines. You may also have to pay for the
cost of postage or shipping, depending on how you ask that we get
these copies to you.
Amendment:
You may ask us to amend your health information if you believe that
it is incorrect or incomplete. Your request must be in writing and
must include a reason to support the amendment. Your request may
be denied if we believe that the information is complete and accurate,
if the information is not part of the medical information that you
would be permitted to inspect or copy, or if we did not create the
information. If we amend the records, we will automatically provide
notice of a change in your records to any entity with which we shared
the record in the past 6 months or to anyone designated by you.
Accounting
of Disclosures: You may request a list of non-routine disclosures
that we have made of your medical information over the previous
six (6) years. This does not include disclosures we make for your
treatment, to seek payment for our services, or for our normal business
operations as noted in the section on permitted uses and disclosures,
or for those you authorize in writing. You may not request an accounting
for dates of service prior to April 14, 2003. Your first request
within a 12-month period is free, but we may charge for additional
lists within the same 12-month period.
Paper Copy
of This Notice: You are entitled to receive a paper copy of
our Notice of Privacy Practices by contacting our Privacy Coordinator
using the contact information on the first page.
File a Complaint:
If you believe that we have violated your privacy rights, you may
file a complaint directly with our Privacy Coordinator using the
contact information on the first page. You may also file a complaint
with the Secretary of the Department of Health and Human Services.
We will not penalize you for complaining.
Patient
Authorizations for Certain Disclosures
We will request your written authorization for uses and disclosures
of your medical information that we did not identify in this notice
or for those not otherwise permitted by law. These disclosures include
your requests to provide exam results to your attorney, for exams
related to life insurance or disability insurance applications,
or for pre-employment physicals, among others. Your authorization
is valid for one year after you grant it, unless you specify a shorter
time. You may revoke your authorization in writing at any time by
contacting our Privacy Coordinator using the contact information
on the first page.
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